Lack of Impact of Direct-to-Consumer Advertising on the Physician-Patient Encounter in Primary Care: A SNOCAP Report

Abstract

PURPOSE Direct-to-consumer advertising (DTCA) has increased tremendously during the past decade. Recent changes in the DTCA environment may have affected its impact on clinical encounters. Our objective was to determine the rate of patient medication inquiries and their infl uence on clinical encounters in primary care. METHODSOur methods consisted of a cross-sectional survey in the State Networks of Colorado Ambulatory Practices and Partners, a collaboration of 3 practice-based research networks. Clinicians completed a short patient encounter form after consecutive patient encounter for one-half or 1 full day. The main outcomes were the rate of inquiries, independent predictors of inquiries, and overall impact on clinical encounters. RESULTSOne hundred sixty-eight clinicians in 22 practices completed forms after 1,647 patient encounters. In 58 encounters (3.5%), the patient inquired about a specifi c new prescription medication. Community health center patients made fewer inquiries than private practice patients (1.7% vs 7.2%, P <.001). Predictors of inquiries included taking 3 or more chronic medications and the clinician being female. Most clinicians reported the requested medication was not their fi rst choice for treatment (62%), but it was prescribed in 53% of the cases. Physicians interpreted the overall impact on the visit as positive in 24% of visits, neutral in 66%, and negative in 10%.CONCLUSIONS Patient requests for prescription medication were uncommon overall, and even more so among patients in lower income groups. These requests were rarely perceived by clinicians as having a negative impact on the encounter. Future mixed methods studies should explore specifi c socioeconomic groups and reasons for clinicians' willingness to prescribe these medications.

Card Studies for Observational Research in Practice

“…Another SNOCAP study examined direct-to-consumer advertising. 21 During 1 day of patient care, the clinician completed a card for every patient seen. If the patient requested a medication during the visit, the clinician completed the entire card; otherwise, the clinician completed just the basic patient demographics.…”

A Way Forward for Health Care and Healers

“…• Overcoming fragmented health care 12 • Refocusing generalists and specialists on their most effective and effi cient roles and shared care 13 • Using listening and relationship rather than tests to foster a sense of patient well-being 14 • Implementing incentives so that they do more good than harm 15 • Improving maternity care access and comprehensiveness 16,17 • Reframing our interpretation of the effect of personality on study data completeness 18 • Making the cholesterol-lowering benefi ts of barley tolerable 19 • Improving quality of care 20 • Improving communication with a pause during care and by reforming care away from only brief encounters 21 • Understanding how important health literacy is to effective health care 22 • Approaching the multifactorial nature of asthma and its multilevel treatment 23 • Overcoming underrecognition of the impact of direct-to-consumer advertising on the outpatient visit and prescribing 24 • Fanning or slaking turf wars around who should perform colonoscopy 25 • Assessing the trade-offs involved in using short or long instruments to screen for postpartum depression 26 • Implementing processes for detecting and managing post-myocardial infarction depression 27 • Reconsidering relevancy and bureaucratic load of the National Committee for Quality Assurance assessment of the patient-centered medical home concept 28 • Understanding uncertainty 29 • Considering the trade-offs in paper vs electronic data collection in offi ce-based research 30 We were delighted to see the comments of a residency journal club. 31 We encourage other local journal clubs, and all readers, to join the discussion at http:// www.AnnFamMed.org…”

Exploring Strategies to Enhance the Presentation of Information in Print DTCA to Improve Consumers’ Recall of Information

“…Proponents of DTCA state that the advertisements provide consumers with valuable educational information that can bring financial and health related benefits. 2,3 Opponents of DTCA state that the advertisements provide consumers with incomplete and biased information that may generate unnecessary visits and inappropriate requests for medications. 1,3 In the midst of these debates, the Food and Drug Administration (FDA) created guidelines to regulate DTCA.…”

“…2,3 Opponents of DTCA state that the advertisements provide consumers with incomplete and biased information that may generate unnecessary visits and inappropriate requests for medications. 1,3 In the midst of these debates, the Food and Drug Administration (FDA) created guidelines to regulate DTCA. Within the guidelines, the presentation of a fair balance between benefit and risk information in DTCA is considered to be a fundamental component because the FDA believes that consumers are more likely able to make informed and conscious evaluations and decisions when they are presented with both sides of the information.…”